The Sinclair MethodUK Information and Providers

What is The Sinclair Method?

The Sinclair Method (TSM) is an evidence-based treatment approach for Alcohol Use Disorder (AUD) that uses medication to gradually reduce alcohol cravings and consumption. Unlike traditional abstinence-based programmes that require you to stop drinking immediately, TSM works by allowing you to continue drinking while taking a medication that blocks the pleasurable effects of alcohol.

At the core of TSM is the concept of pharmacological extinction – using medication to interrupt the brain's learned association between alcohol and pleasure. When you drink alcohol, your brain normally releases endorphins (natural opioids) that create feelings of reward and reinforcement. The medication naltrexone blocks these endorphins from reaching their receptors, meaning you don't experience the usual "buzz" or euphoria from drinking.

Over time – typically 3 to 4 months – your brain gradually "unlearns" its connection between alcohol and reward. Cravings naturally diminish, and most people find themselves drinking significantly less or choosing not to drink at all. This process doesn't rely on willpower; it works at a neurological level to change how your brain responds to alcohol.

History and Development

The Sinclair Method was developed by Dr John David Sinclair, an American neuroscientist who conducted extensive research on alcohol addiction at the National Public Health Institute in Finland. Beginning in the 1960s, Dr Sinclair studied the neurological mechanisms underlying alcohol dependence and discovered that alcohol's rewarding effects were mediated primarily through the brain's opioid system.

Dr Sinclair's breakthrough came when he observed that the opioid antagonist naltrexone could block the reinforcing effects of alcohol in laboratory studies. He hypothesised that if patients took naltrexone before drinking – rather than daily with abstinence – the medication could systematically weaken the learned association between alcohol and pleasure over multiple drinking sessions.

In the 1990s, Dr Sinclair conducted clinical trials in Finland that demonstrated the effectiveness of this "targeted" use of naltrexone. His research showed that patients who took naltrexone only before drinking achieved better long-term outcomes than those who took it daily while abstaining. The method gained wider recognition following the publication of The Cure for Alcoholism by Dr Roy Eskapa in 2008.

How The Sinclair Method Works

The Sinclair Method follows a specific protocol that differs significantly from traditional alcohol treatment approaches:

The Science: Pharmacological Extinction

How Alcohol Creates Addiction

When you drink alcohol, it triggers the release of endorphins – the brain's natural opioids – which bind to opioid receptors and create feelings of pleasure, relaxation, and euphoria. This is the "buzz" that many people experience. Over time, your brain learns to associate drinking with this reward, creating powerful neural pathways that reinforce the behaviour through operant conditioning.

How Naltrexone Enables Extinction

Naltrexone is an opioid antagonist that binds to opioid receptors and blocks them. When you take naltrexone before drinking, the endorphins released by alcohol cannot bind to the blocked receptors and therefore cannot produce the usual reward signal. You still experience the sedative effects of alcohol, but not the pleasurable "buzz."

This is where extinction occurs. In behavioural psychology, extinction is the process by which a learned behaviour weakens when it is no longer reinforced. Just as Pavlov's dogs eventually stopped salivating at the bell when food no longer followed, your brain gradually stops craving alcohol when drinking no longer produces pleasure.

Why Abstinence Alone May Not Work

Traditional abstinence-based treatment requires stopping drinking immediately. While this helps many people, it has a limitation: abstinence does not change the brain's learned association between alcohol and pleasure. The neural pathways remain intact, which is why many people experience persistent cravings years into sobriety.

The Sinclair Method addresses this by actively weakening the reward association through repeated unreinforced drinking episodes. Each time you drink with naltrexone, you teach your brain that alcohol no longer delivers the expected reward.

Medications Used: Naltrexone and Nalmefene

Naltrexone

• Dosage: 50mg tablets taken orally at least one hour before drinking
• Mechanism: Blocks mu- and delta-opioid receptors
• Approval: FDA approved for AUD in 1994; available on NHS prescription in UK
• Cost: Approximately £60-85 for 28 tablets (private); NHS prescription charge if obtained through GP

Nalmefene (Selincro)

• Dosage: 18mg tablets taken one hour before drinking
• Mechanism: Blocks mu- and delta-opioid receptors, partial antagonist at kappa receptors
• Approval: Approved by NICE in 2014 for reducing alcohol consumption
• Availability: May be available on NHS in some areas; otherwise available privately

Research Evidence and Success Rates

A landmark meta-analysis published in JAMA in 2014 reviewed 122 randomised controlled trials of pharmacotherapy for alcohol use disorder. The analysis found that oral naltrexone significantly reduced return to any drinking (NNT = 20) and return to heavy drinking (NNT = 12).^[1]

Dr Sinclair's original research demonstrated a 78% success rate when naltrexone was used according to his targeted protocol. This figure comes from controlled clinical trials and is widely cited in TSM literature.^[2]

In the UK, the National Institute for Health and Care Excellence (NICE) recommends naltrexone as a first-line pharmacological treatment for alcohol dependence (Clinical Guideline CG115).^[3]

Pros and Cons of The Sinclair Method

Advantages

• No immediate abstinence required: More accessible for those not ready to quit immediately
• Addresses the neurological root cause: Works at the brain level rather than relying solely on willpower
• Strong evidence base: Supported by decades of clinical research and NICE guidelines
• Flexibility: Goal can be moderation or abstinence
• Non-addictive medication: Naltrexone does not produce dependence
• Can be combined with support: Works alongside counselling or coaching

Limitations

• Requires strict compliance: Must take medication before every drink
• Not suitable for everyone: Contraindicated with opioid use, severe liver disease, pregnancy
• Does not address underlying issues: Doesn't treat psychological factors like trauma or depression
• Variable results: Not everyone responds equally
• Side effects: Some experience nausea, headache, or fatigue

Side Effects and Safety

Common Side Effects (usually temporary)

• Nausea – most commonly reported, usually improves after first few doses
• Headache
• Dizziness
• Fatigue or drowsiness
• Difficulty sleeping
• Reduced appetite

Important Safety Considerations

• Opioid interaction: Naltrexone blocks ALL opioids – you cannot take opioid pain medications while on naltrexone
• Liver function: Tests may be required before and during treatment
• Pregnancy: Not recommended during pregnancy or breastfeeding
• Still causes impairment: Never drive after drinking, even on naltrexone